Request for Accommodations Form

Thank you for submitting your request for accommodations.

By submitting this form you are signifying you have read and agree to the Rights and Responsibilities.

Once your application has been processed, you will be contacted via email to set up an appointment to discuss your accommodation needs.

Complete and submit this form in its entirety.

I have reviewed the Rights and Responsibilities. My submission of this form signifies I have read and agree to my Rights and Responsibilities.

If you are requesting an Emotional Support Animal (ESA) as an accommodation, please go to the ESA request form.

* indicates required field

Complete and submit this form in its entirety.

I have reviewed the Rights and Responsibilities. My submission of this form signifies I have read and agree to my Rights and Responsibilities.

If you are requesting an Emotional Support Animal (ESA) as an accommodation, please go to the ESA request form.

* indicates required field

All official University business will be conducted via MSUM email accounts. It is essential that you access, read and use your go.mnstate.edu account.

All official University business will be conducted via MSUM email accounts. It is essential that you access, read and use your go.mnstate.edu account.

Are you living on campus?*
Reason for applying:*

Diagnostic Information

Please identify any disability/disabilities that you have been diagnosed with:*

History of Accommodations

Documentation from a qualified professional must be shared with Accessibility Resources.

Documentation from a qualified professional must be shared with Accessibility Resources.

If you do not receive a copy of this form in your email that this form was submitted successfully, please contact the Accessibility Resources Office.

If you do not receive a copy of this form in your email that this form was submitted successfully, please contact the Accessibility Resources Office.